中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4344-4347.doi: 10.12307/2021.194

• 人工假体 artificial prosthesis • 上一篇    下一篇

滑膜液α防御素和C-反应蛋白在关节假体周围感染诊断中的价值

贺生才，蒋成丹，荆纯祥，罗敏怡，马兴发，李嘉洲，潘华山   

  1. 1广州中医药大学体育健康学院，广东省广州市   510006；2广东食品药品职业学院科技处，广东省广州市   510520
  • 收稿日期:2019-12-24 修回日期:2019-12-26 接受日期:2020-09-03 出版日期:2021-09-28 发布日期:2021-04-10
  • 通讯作者: 潘华山，硕士，教授，博士生导师，广东食品药品职业学院科技处，广东省广州市 510520
  • 作者简介:贺生才，男，1994年生，四川省泸州市人，汉族，广州中医药大学在读硕士，主要从事运动损伤的临床治疗与康复方面的研究。

Values of alpha defensin and C-reactive protein in synovial fluid in the diagnosis of periprosthetic infection

He Shengcai, Jiang Chengdan, Jing Chunxiang, Luo Minyi, Ma Xingfa, Li Jiazhou, Pan Huashan   

  1. 1School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 2Department of Science and Technology, Guangdong Food and Drug Vocational College, Guangzhou 510520, Guangdong Province, China
  • Received:2019-12-24 Revised:2019-12-26 Accepted:2020-09-03 Online:2021-09-28 Published:2021-04-10
  • Contact: Pan Huashan, Master, Professor, Doctoral supervisor, Department of Science and Technology, Guangdong Food and Drug Vocational College, Guangzhou 510520, Guangdong Province, China
  • About author:He Shengcai, Master candidate, School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China

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摘要：

文题释义：
α防御素：是一种由多形核细胞针对感染产生的非特异性抗菌蛋白，是人固有免疫系统的组成成分。由于病原体细胞膜上抗原的存在，蛋白防御素和其他抗菌蛋白可从中性粒细胞等先天免疫系统细胞中释放，并在氧依赖吞噬作用中发挥作用。
Ｃ-反应蛋白：是一种急性时相血浆蛋白，在全身炎症反应过程中增加，是常用的炎症标志物之一。有研究指出Ｃ-反应蛋白在假体周围感染患者的滑膜液中的含量也会增高。

背景：假体周围感染是膝/髋关节置换最常见最严重的并发症之一，占全膝关节置换失败原因的25%，全髋关节置换失败的16%。因此，及时准确地诊断关节假体周围感染具有重要临床意义。
目的：评估α防御素和C-反应蛋白对假体周围感染的诊断效应。
方法：选取2014年9月到2016年9月初次关节置换或关节翻修手术后疼痛的患者，并检测所选患者滑膜液中α防御素和C-反应蛋白的表达情况，并与肌肉骨骼感染协会(MSIS)标准对比，分别计算检测的阳性预测值和阴性预测值。试验于2020-08-07经广州中医药大学伦理审查委员会批准，审批号K[2020]064。
结果与结论：α防御素测试与滑膜液C-反应蛋白阳性联合测试的敏感性为81.1%(95% CI：64.8%-92.0%)，特异性为95.9%(95% CI：91.3%-98.5%)；滑膜液α防御素和C-反应蛋白联合测试的敏感性为73.0% (95% CI：55.9%-86.2%)，特异性为99.3%(95% CI：96.2%-99.9%)。提示滑膜液中α防御素和C-反应蛋白可用于关节周围感染的辅助诊断。
https://orcid.org/0000-0003-4806-9800 (贺生才) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: α防御素, C-反应蛋白, 假体周围感染, 临床评估, 关节置换, 术后疼痛, 并发症, 诊断试验

Abstract: BACKGROUND: Peri-prosthesis infections are one of the most common and serious complications of knee/hip replacement, accounting for 25% of total knee replacement failures and 16% of total hip replacement failures. Therefore, timely and accurate diagnosis of periarticular prosthesis infection has important clinical significance.  
OBJECTIVE: To evaluate the diagnostic effects of α defensin and C-reactive protein on periprosthetic infections.
METHODS:  Patients with pain following primary or revision joint surgery from September 2014 to September 2016 were selected for alpha defenesin and C-reactive protein testing in synovial fluid. The results were compared with Muscular Skeletal Infection Society standard, and the positive predictive value and negative predictive value were calculated. The trial was approved by the Ethics Committee of Guangzhou University of Chinese Medicine (approval No. K[2020]064) on August 7, 2020.  
RESULTS AND CONCLUSION: The sensitivity and specificity of α defensin test combined with synovial fluid C-reactive protein positive test were 81.1% (95% CI: 64.8%-92.0%) and 95.9% (95% CI: 91.3%-98.5%). The sensitivity and specificity of α defensin and C-reactive protein in synovial fluid were 73.0% (95% CI: 55.9%-86.2%) and 99.3% (95% CI: 96.2%-99.9%). It is concluded that both α defensin and C-reactive protein in synovial fluid can be used in the diagnosis of periarticular infection.

Key words: alpha defensins, C-reactive protein, periprosthetic infection, clinical evaluation, joint replacement, postoperative pain, complications, diagnostic test

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